Tuesday, April 26, 2011

ACO Tithing and Putting Clinical Inertia Into Perspective. Good News There's a Toolkit That Can Help!

To the rescue!

While the health establishment's shakers and movers spin on axis over all the wonderful things ACOs will do to transform health care, the Disease Management Care Blog has been asking experts closer to the clinical trenches what they're hearing. It's not enthusiastic. Skepticism aside, why shouldn't they take a pass? Recall that the upside gainsharing gives the first 2% to the Feds, leaving ACOs 60% of what follows. So, if claims savings are, say, 5%, the DMCB calculates that ACOs get to keep 1.5% out of that 5%. 1.5 divided by 5 is 30%, leaving 70% for Uncle Sam. Not even God takes that much.

And one of the things that ACOs are supposed to do is usher in a new era of evidence-based medicine. The DMCB has its doubts about that too (more on that below), but for something completely different, check out this JAMA Commentary by Dario Giugliano and Katherine Esposito on "clinical inertia." It turns out that there are a number of peer-reviewed diabetes, hypertension and cholesterol studies that cast doubt on the wisdom of striving for universally low A1cs, systolic blood pressures and LDLs. While our leaders tut-tut the medical establishment's failure to achieve 100% compliance with academic-expert opinion (or its benefactors), Drs. Guigliano and Esposito wonder if some physicians could have a very reasonable doubt about the evidence or may be reacting with justifiable uncertainty. If they're right, clinical inertia may be more of a patient safeguard than generally appreciated.

Yet, while the DMCB is being an ACO weenie, that hasn't stopped it from trying to be of help. That's why it participated in the development of this Care Continuum Alliance "toolkit" titled "Achieving Accountable Care: Essential Population Health Management Tools for ACOs." You can download this expertly edited and heavily referenced review here.

In the toolkit, readers will be able to learn about the many other interventions necessary to successfully manage that all important "attributed" population. That includes using health risk assessments (HRAs), taking full advantage of risk stratification (predictive modeling), maximizing patient enrollment in clinical programs, putting clinical guidelines into perspective with targeted decision support and shared decision making (the answer to the conundrum described above), leveraging nurse-led care management programs, really taking advantage of health information technology, measuring everything and working with third parties to build programs. Do all these things, says the DMCB, and your ACO will have a much better shot at making a real difference. It might even make some money.

As a reminder, the DMCB will be discussing this more fully in a CCA hosted webinar later this week. Registration info here.

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About Jaan Sidorov MD, MHSA, FACP

While his web persona has been described as a "blogvocateur," Dr. Sidorov has wide range of knowledge about the medical home, condition management, population-based health care and managed care that is only exceeded by his modesty. He has been quoted by the Wall Street Journal, Consumer Reports and NPR’s All Things Considered.
He has over 20 years experience in primary care, disease management and population based care coordination. He is a primary care general internist and former Medical Director at Geisinger Health Plan.
He is primary care by training, managed care by experience and population-based care strategies by disposition.
The contents of this blog reflect only the opinions of Sidorov and should not be interpreted to have anything to do with any current or past employers, clients, customers, friends, acquaintances or enemies, personal, professional, foreign or domestic. This is also not intended to function as medical advice. If you really need that, work with a personal physician or call 911 for crying out loud.
Jaan can be reached at jaansATaolDOTcom.